LAUSR

Editorial for “Value of Dynamic Contrast Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations” Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) is an advanced imaging approach that harnesses the changes in local magnetic environment due to the intravenous injection of gadolinium-containing compound. DCE requires the acquisition of multiple T1-weighted images during the passage of the contrast agent through the organ of interest. These images, in conjunction with, are subsequently analyzed using model-free or model-dependent approaches. Conventionally, the signal acquired during DCE acquisitions is thought to be influenced by vascular permeability and tissue perfusion, allowing for complex models of tissue function to be fit to the imaging data. Clinically, DCE has primarily found use in oncological imaging, in particular the staging of prostate cancer. Vascular malformations are congenital disorders due to localized defects of vascular morphogenesis that lead to an abnormal network of lymphatic or blood vessels. Venous malformations (VMs) are divided into slow-flow or fast-flow and, according to the predominant vascular component, subcategorized in capillary malformation, VM, lymphatic malformation, and arteriovenous malformation. Conventional treatment of VMs relies upon surgical intervention, or injection of sclerosants to cause blood vessel fibrosis. However, VM sclerotherapy efficacy is highly dependent on venous perfusion in the region—with hypoperfusing regions good candidates for therapeutic intervention. Hyper-perfusing regions commonly have a poor response to sclerotherapy, primarily due to the lack of sclerosing agent accumulation in the VM. Therefore, harnessing DCE-MRI to assess VM blood flow prior to therapy may be of use in the clinic. In this issue of JMRI, Xia et al undertook a retrospective study to assess the potential utility of DCE-MRI in understanding outcome after foam sclerotherapy of VMs. Fifty-five patients were recruited in this study, all receiving foam sclerotherapy with a follow-up MRI after 6 months. Three-dimensional T1-weighted imaging was performed before and after an injection of gadolinium-containing contrast, for a total of eight measurements (two prior to injection and six post). Two-dimensional and three-dimensional analyses were performed for each lesion, with lesion morphology, assessed semiquantitative DCE parameters calculated and histogram analysis performed. Receiver operator and area under the curve (AUC) analysis was performed to assess the optimal combination of imaging features to discriminate between effective and ineffective therapy groups. The results of the study demonstrate that DCE-MRI, and subsequent semiquantitative and histogram-based imaging features, was able to classify effective and ineffective lesions with high accuracy, AUC = 0.9 for 2D and 0.96 for 3D image analysis methods, respectively. This study has shown the potential power of DCEMRI in the pre-operative assessment of VMs, with results showing promise for a prospective study in a larger patient population, in multiple institutions. With this study presenting initial evidence for more personalized approaches for VM management, there would potentially be both an increased patient quality of life and savings for healthcare systems in the future.